1st International Conference on Advances in Obstetrics & Gynaecology : Oral Presentations - Selected abstractsSultan Qaboos University, 4–6 December 2013

In the era of assisted reproductive techniques (ART), the current challenge is to accommodate established and new treatment modalities that are both cost-effective and evidence-based. The presentation reviews the evolving concepts in male infertility for gynaecologists involved in the care of men and women experiencing difficulty in conceiving. Novel diagnostic testing allows the identification of a significant proportion of patients previously misdiagnosed as having idiopathic or unexplained male infertility. Sperm deoxyribonucleic acid fragmentation and oxidative stress are two of the tests already available in the modern clinical andrology laboratory; their results aid the clinician to define the best management strategy. When treating the male partner by medical and surgical therapy, our focus is not only to improve the couple’s chance of having an unassisted pregnancy but also to ameliorate their chances of success with ART. The use of oral antioxidant supplementation is now commonplace, especially given the evidence that antioxidants improve the outcomes of pregnancy and live birth in subfertile couples undergoing ART. Hormonal therapy, including aromatase inhibitors and recombinant human chorionic gonadotropin, are easy-to-use medications intended to treat hypogonadal infertile males. In the surgical field, we have incorporated microsurgery to treat common male diseases such as varicocele; this not only increases the chances of spontaneous conception, but also increases the likelihood of pregnancy with ART. For azoospermic men with obstructive problems, microsurgery offers the best method to reconstruct the reproductive tract. The method also improves the likelihood of retrieving sperm for use with intracytoplasmic sperm injections for azoospermic men with non-treatable conditions, such as those with non-obstructive azoospermia.